| Henoch-Schonlein purpura nephritis(HSPN) is the secondary kidney damage of the Henoch-Schonlein purpura(HSP). It is a type of secondary glomerulonephritis. The symptoms which includes hematuria, proteinuria, peliosis are recurrent and lingering, which brings psychological distress and economic burden to the patients. The long-term prognosis of HSPN is not optimistic. The pathogenesis of this disease is not clear, it may be associated with immunologic mechanism, inflammatory mechanism, clotting mechanism and genetic mechanism. The western medicine has no definitely effective treatment to this disease. Many experts of Traditional Chinese Medicine(TCM) have rich experience in treating HSPN. The TCM treatment is characterized by syndrome differentiation by stage. However, the researches on the syndrome characteristics which can reflect the association of the syndrome and course time need to be taken into perfect. At present most of the researches on the syndromes aim at child HSPN or adult HSPN. However, the researches on the difference of the syndrome characteristics between these two patient groups are relatively less. My supervisor Professor Nie has accumulated rich experience in treating HSPN with TCM. This research is on the characteristics of the syndromes of HSPN and summary of the experience of Professor Nie in treating this disease with TCM.1.Study of syndrome characteristicsObject:To study the correlation of the characteristics of the syndromes with sex, age groups, course time; to study the differences of hematuria level, albuminuria level and prevalence of hypertension among different syndromes.Method:In the way of clinical investigation, the HSPN cases who hospitalized in the renal department or visit the clinics of the renal department in Xiyuan Hospital from March 2014 to October 2015 were selected. The general characteristics of the TCM syndromes were surveyed. The difference of the syndrome constituent between male and female cases was compared. The difference of the syndrome constituent between mior and adult cases was compared. The differences of the syndrome constituent among different course time groups were compared. The differences of the course time distribution among different syndromes were compared. The differences of the urinary RBC count,24 hour urine protein quantity and prevelance of hypertension among different syndromes were compared.Results:In this research 135 HSPN cases were selected.1.In the 135 cases, the most common syndrome was the syndrome of dificiency of qi and yin,79 cases (accounted for 58.52%). the syndrome of external wind heat took the second place,21 cases(accounted for 15.56%). the syndrome of bleeding due to heat toxin took the third place,16 cases(accounted for 11.85%). the number of the syndrome of qi failing to control blood and essence asthenia was 11 (accounted for 8.15%), the number of the cases of the syndrome of yin dificiency and blood heat was 8(accounted for 5.93%). The number of cases with accompanied syndromes was 92(accouted for 68.15%).2.The ratio of syndrome of external wind heat in the (<30 days)group (37.50%)was more than that in the(≥90 days)group(5.48%)(P<0.001<0.017). The ratio of the syndrome of bleeding due to heat toxin in the (<30 days)group(25.00%) and (≥30 and< 90 days)group (20.00%)was more than that in the(≥ 90 days)group(2.74%)(P<0.017).The ratio of the syndrome of dificiency of qi and yin in the (<30 days)group (25.00%)and (≥30 and<90 days)group(50.00%) was less than that in the(≥90 days)group(76.7%)(P<0.017).No difference had been found in the result of the comparison of the ratio among other syndromes in different course period groups (P>0.017).3.The distribution of the course duration of the syndrome of external wind heat(quartile 15(4.5,67)days)was earlier than that of the syndrome of yin dificiency and blood heat(quartile 168.5(70,573.5)days)and the syndrome of dificiency of qi and yin(quartile 275(72,87)days)(P<0.01). The distribution of the course duration of the syndrome of bleeding due to heat toxin (quartile 29(6,41.5)days)was earlier than that of the syndrome of yin dificiency and blood heat and the syndrome of dificiency of qi and yin(P<0.01). No difference was found in the result of comparison of the distribution of the course duration among other syndromes.(P> 0.01).4.The ratio of syndrome of external wind heat in the minor group (31.03%)was more than that in adult group(3.90%)(P<0.001<0.05). The ratio of the syndrome of qi failing to control blood and essence asthenia in the minor group(0%)was less than that in adult group(14.29%)(P=0.003<0.05). The ratio of the syndrome of dificiency of qi and yin in the minor group (48.28%)was less than that in adult group(66.23%)(P=0.036< 0.05). No difference was found in the result of comparison of ratio among other syndromes in the two groups(P>0.05).5.The general urinary RBC count of the syndrome of bleeding due to heat toxin (quartile 46.71(15.02,73.91)/HP)was more than the syndrome of dificiency of qi and yin(quartile 12.32(6.2 1,45.90)/HP).6.No difference was found in the result of comparison of ratio among the syndromes between the male group and female group(P>0.05). No difference was found in the result of comparison of prevelance of hypertension among different syndromes(P>0.01). No difference was found in the result of comparison of mean 24 hour urine protein quantity among different syndromes(P>0.01).Conclusion:1. In the 135 cases,the syndrome of dificiency of qi and yin is the most common principle syndromes of HSPN, the principle feature is intermingling of deficiency and excess. The syndrome of the external wind heat is the most common excess syndrome.2. The ratio of the patients who manifest as the syndrome of the external wind heat and the syndrome of bleeding due to heat toxin in the (course duration< 90 days)group is more than that in the (course duration=≥90 days)group. The ratio of the patients who manifest as the syndrome of dificiency of qi and yin (course duration≥90 days)group is more than that in the (course duration< 90 days)group.The distribution of the course duration of the syndrome of external wind heat and the distribution of the syndrome of bleeding due to heat toxin are earlier than the syndrome of yin dificiency and blood heat and the syndrome of dificiency of qi and yin.3. The ratio of the patients who manifest as the syndrome of the external wind heat in the mior group is more than that in the adult group. The ratio of the patients who manifest as the syndrome of dificiency of qi and yin and the syndrome of qi failing to control blood and essence asthenia in the adult group is more than that in the minor group.4. The degree of the hematuria of the patients who manifest as the syndrome of bleeding due to heat toxin is more serious than that of the patients who manifest as the syndrome of dificiency of qi and yin.5. No Relevance has been found between the principle syndrome and sex. No difference has been found in the result of comparison of the degree of proteinuria and prevelance of hypertension among different syndromes.2.Data mining of the prescription medication experience of Professor Nie in treating HSPNObject:To summarize the experience of Professor Nie in treating the HSPN with Traditional Chinese Medicine.Method:The HSPN cases who visited the clinics of Professor Nie from March 2014 to Febrary 2016 were selected. The common traditional Chinese drug were summarized with the method of frequency count. The common drug compatibility were summarized with the method of Association Rules analysis.The association rules were showed in the form of network to summarize the core prescription.The four characters, five tastes and channel entry of the medicine in the prescription were summarized with the method of frequency count..Results:In this research,62 cases,115 prescriptions were selected.1. In the prescription to treat the syndrome of dificiency of qi and yin, the high frequency traditional Chinese drug included:honeysuckle(97 times), Rehmannia Root(94 times), Milkvetch Root(89 times), Arnebia Root(82 times), Gordon Euryale Seed(82 times), Heterophylly Falsesatarwort Root(81 times), Field Thistle Herb(79 times), etc. The treatment shown from the high frequency Chinese drugs included: tonifying qi and yin, removing toxicity and relieving sore throat, hemostasis and astringe essence.In the condition that the minimum Support was set to be 50% and minum Confidence was set to be 90%, compatibility of medicines embodied from the association rules included:The compatibility to strengthening healthy energy:Chinese Angelica and Rehmannia Root(Confidence 100.00%, Support 52.58%), White peony Alba and Chinese Angelica(Confidence 100.00%, Support 74.23%), Milkvetch Root and Rehmannia Root(Confidence 96.63%, Support 88.66%), etc.The compatibility to eliminating evil:gypsum and honeysuckle(Confidence 100.00%, Support 56.70%).The compatibility to strengthening healthy energy and eliminating evil: Heterophylly Falsesatarwort Root and honeysuckle(Confidence 100.00%, Support 91.75%), Milkvetch Root and honeysuckle(Confidence 100.00%, Support 91.75%), gypsum and Rehmannia Root (Confidence 96.36%, Support 54.64%), etc.The compatibility to strengthening healthy energy and consolidate the enssence: Gordon Euryale Seed and Milkvetch Root(Confidence 90.24%, Support 76.29%), Arnebia Root and Rehmannia Root(Confidence 97.56%, Support 82.47%), Field Thistle Herb and Rehmannia Root(Confidence 97.47%, Support 79.38%), etc.The compatibility to clearing heat and cooling blood to stop bleeding and clearing heat and control essence:honeysuckle and Gordon Euryale Seed(Confidence 100%,Support 84.54%), Field Thistle Herb and honeysuckle(Confidence 100.00%,Support 81.44%), Arnebia Root and honeysuckle(Confidence 100.00%, Support 84.54%), etc.The compatibility to control bleeding and essence:Field Thistle Herb and Gordon Euryale Seed(Confidence 91.14%, Support 74.23%).The core composition of the traditional Chinese drug extracted from the association rules to treat the syndrome of dificiency of qi and yin was:Heterophylly Falsesatarwort Root, Milkvetch Root, Rehmannia Root, Chinese Angelica,White peony Alba,Field Thistle Herb, Gordon Euryale Seed, honeysuckle, Arnebia Root, gypsum, radix stellariae, Smoked Plum, Chinese Magnolivine Fruit, Pheretima, Divaricate Saposhnikovia Root.2. In the prescription to treat the syndrome of qi failing to control blood and essence asthenia, the high frequency traditional Chinese drug included:parched Largehead Atractylodes Rhizome(15 times), Field Thistle Herb(14 times), mythic fungus(12 times), Poria cocos(12 times), Milkvetch Root(12 times), Villous Amomum Fruit(11 times), honeysuckle(11 times), Heterophylly Falsesatarwort Root(11 times), Isatis Root(10 times), Coix Seed(10 times), Divaricate Saposhnikovia Root(10 times), Common Yan Rhizome(10 times), Gordon Euryale Seed(10 times), etc. The treatment shown from the high frequency Chinese drugs included:Tonifying qi of spleen and lung, removing toxicity and relieving sore throat, hemostasis and astringe essence.In the condition that the minimum Support was set to be 50% and minum Confidence was set to be 90%, compatibility of medicines embodied from the association rules included:The compatibility to strengthening healthy energy includes:the compatibility to tonify qi, the compatibility to invigorate the spleen and the compatibility to tonify lung.The compatibility to tonify qi included:Heterophylly Falsesatarwort Root and Milkvetch Root(Confidence 90.91%, Support 66.67%). The compatibility to invigorate spleen:Poria cocos and parched Largehead Atractylodes Rhizome(Confidence 100.00%, Support 80.00%), Milkvetch Root and parched Largehead Atractylodes Rhizome(Confidence 100.00%, Support 80.00%), Dried Tangerine peel and Common Yan Rhizome(Confidence 100.00%, Support 60.00%), etc. The compatibility to tonify lung:Divaricate Saposhnikovia Root and parched Largehead Atractylodes Rhizome(Confidence 100.00%, Support 66.67%), mythic fungus and parched Largehead Atractylodes Rhizome(Confidence 100.00%, Support 80.00%).The eliminating evil medicine in the prescrition were mainly composed by dispelling the wind and heat and relieving sore-throat medicines.They always coorperated with other medicine. The compatibility to clearing heat and relieving sore-throat medicines:Gordon Euryale Seed and honeysuckle(Confidence 100.00%, Support 66.67%);The compatibility to clearing heat, relieving sore-throat and stop bleeding:honeysuckle and Field Thistle Herb(Confidence 100.00%, Support 77.73%), Isatis Root and Field Thistle Herb(Confidence 100.00%, Support 66.67%); The compatibility to invigorate spleen, clearing heat and relieving sore-throat medicines:honeysuckle and parched Largehead Atractylodes Rhizome(Confidence 100.00%, Support 77.73%), Isatis Root and parched Largehead Atractylodes Rhizome(Confidence 100.00%, Support 66.67%).The medicines to strengthening healthy energy always coorperated with medicine to control essence and stop bleeding. The compatibility to invigorate spleen and control the essence:Gordon Euryale Seed and parched Largehead Atractylodes Rhizome(Confidence 100.00%, Support 66.67%); the compatibility to invigorate spleen and stop bleeding:Field Thistle Herb and parched Largehead Atractylodes Rhizome(Confidence 100.00%, Support 93.33%), etc; the compatibility to tonifying qi and stop bleeding:Heterophylly Falsesatarwort Root and Field Thistle(Confidence 90.91%, Support 66.67%), Milkvetch Root and Field Thistle(Confidence 91.67%, Support 73.33%), etc.The compatibility to control the essence and stop bleeding:Gordon Euryale Seed and Field Thistle Herb(Confidence 100.00%, Support 66.67%).The core composition of the traditional Chinese drug extracted from the association rules to treat the syndrome of qi failing to control blood and essence asthenia was:Heterophylly Falsesatarwort Root, Milkvetch Root, Poria cocos, parched Largehead Atractylodes Rhizome, Common Yan Rhizome, Villous Amomum Fruit, Coix Seed, Dried Tangerine peel, mythic fungus, Isatis Root, Milkvetch Root, Gordon Euryale Seed, Field Thistle Herb, radix stellariae, Smoked Plum, Chinese Magnolivine Fruit, Pheretima, Divaricate Saposhnikovia Root.3. Two case records of Professor Nie treating the syndrome of external wind heat were selected.Prescription record 1:honeysuckle, Weeping Forsythia Capsule,henon bamboo leaf.Fineleaf Schizonepeta Herb,Great Burdock Achene,mint, Licorice Roots Northwest Origin, Platycodon Root, Reed Rhizome, Heartleaf Houttuynia Herb, Baical Skullcap Root.Prescription record 2:Mulberry Leaf, chrysanthemum, Great Burdock Achene,. apricot seed, Weeping Forsythia Capsule, Reed Rhizome, Licorice Roots Northwest Origin, mint, Charred Radix Scutellariae, Heartleaf Houttuynia Herb, trichosanthes peel, Thunberg Fritillary Bulb, gypsum, Arnebia Root, loquat leaf.4. One case record of Professor Nie treating the syndrome of yin dificiency and blood heat was selected. The prescription record:Arnebia Root, Rehmannia Root, radix stellariae, Pheretima, Chinese Magnolivine Fruit, Field Thistle Herb, Hairyvein Agrimonia Herd, Yerbadetajo Herb, gypsum, Isatis Root, honeysuckle, Gordon Euryale Seed, Great Burdock Achene, panax notoginseng powder.5. In the prescriptions of Professor Nie, the cold property medicine(44.77%)represented the greatest proportion, the other properties were in ordered (from most to least)of mild property(26.53%), warm property(23.34%), cool property(5.31%), hot property(0.04%). The sweat taste medicine(40.52%) represented the greatest proportion, Bitter taste represented the second(23.77%), the other tastes were in ordered (from most to least)of acrid taste(13.29%), sour taste(9.80%), astringent taste(6.76%), salty taste(5.86%).6. The traditional Chinese drugs in the prescription of Professor Nie were mainly attributive to these meridians(ordered from most to least):liver meridian, heart meridian, spleen meridian, lung meridian, stomach meridian, kidney meridian. It showed that the high frequecy medicine attributive to liver meridian included: Rehmannia Root, Field Thistle Herb, Arnebia Root, etc. The high frequecy medicine attributive to heart meridian included:honeysuckle, Rehmannia Root, Field Thistle Herb,Arnebia Root,etc. The high frequecy medicine attributive to spleen meridian included:Milkvetch Root, Gordon Euryale Seed, Heterophylly Falsesatarwort Root, White peony Alba, etc. The high frequecy medicine attributive to lung meridian included:honeysuckle, Milkvetch Root, Heterophylly Falsesatarwort Root, gypsum, etc. The high frequecy medicine attributive to stomach meridian included: honeysuckle, gypsum, Isatis Root, Great Burdock Achene, Baical, etc. The high frequecy medicine attributive to kidney meridian included:Rehmannia Root, Gordon Euryale Seed, Yerbadetajo Herb, Egg Capsule of Mantid.Conclusion:1.From the result of data minning, the prescription idea of Professor Nie to treat HSPN could be summarized in such aspects:① Symptomatic treatment in acute condition, emphasize dispelling wind and heat, clearing toxin. ② Radical treatment in chronic condition:Tonifying qi and yin,strenthing and clearing, moderate supplementation; cooling blood for hemostasis, harmonizing the blood, using blood activating medicine with caution; taking account of elimating evil, emphasizing prevention; combining TCM with western medicine, drawing the useful experience from others.2. The result of medicine combination shows that Professor Nie emphasizes the combination of treatments including strengthening vital energy, eliminating evil, hemostasis and astringing essence.3. The result of statistics of the property and taste of the medicine shows Professor Nie emphasizes moistening and mild tonification in the nourishing treatment, and avoids to increase heat.4. The medication idea of Professor Nie reflected from the results of the analysis of meridian distribution includes:cooling the heat in the blood and nutrient of heart and liver meridian, dispelling exterior wind and heat evil, clearing the excessive heat in the lung and stomach meridian, invigorating qi in the lung and spleen meridian, nourishing yin in the liver and kidney meridian.5. The characteristic of Professor Nie’s treatment of HSPN includes:Clearing the heat of lung and stomach with gypsum and Scutellaria baicalensis to treat the purpura; In addition to treatment based on syndrome differentiation, laying emphasis on application of the clearing heat, removing toxicity and relieving sore throat medicine as the combined medication. |
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